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		<title>Omegapoint AB Robera</title> 
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		<div data-role="page" id="image-page">
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						<span class="ui-btn-text">Options</span>
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                <div id="gallery" class="thumbnailgallery">
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                <div class="image-meta-data">

                    <h5>Created on</h5>
                    <span id="spanCreatedOn" style="font-size: 12px;"></span>

                    <h5>Image Id</h5>
                    <span id="spanImageId" style="font-size: 12px;"></span>

                    <h5>Patient id:</h5>
                    <input type="text" id="tbPatientId" placeholder="000000"  class="input-block-level"></input>

					<h5>Diagnosis</h5>
					<select id="Diagnosis" placeholder="Select Diagnosis"  class="input-block-level">
						<option id="diagnosis1" value="Exfoliativ dermatit">Exfoliativ dermatit</option>
						<option id="diagnosis2" value="Impetigo (svinkoppor)">Impetigo (svinkoppor)</option>
						<option id="diagnosis3" value="Bockharts follikulära impetigo">Bockharts follikulära impetigo</option>
						<option id="diagnosis4" value="Sekundärinfekterade dermatoser">Sekundärinfekterade dermatoser</option>
						<option id="diagnosis5" value="Kutan abscess, furunkel, karbunkel">Kutan abscess, furunkel, karbunkel</option>
					</select>

					<h5>Bodypart</h5>

					<select id="Bodypart" placeholder="Select Bodypart"  class="input-block-level">
						<option id="bodypart1" value="head-face-cervix">Head, face and cervix</option>
						<option id="bodypart2" value="thorax">Thorax</option>
						<option id="bodypart3" value="abdomen">Abdomen</option>
						<option id="bodypart4" value="pelvis">Pelvis</option>
						<option id="bodypart5" value="lower-extremity">Lower extremity</option>
						<option id="bodypart6" value="upper-extremity">Upper extremity</option>
					</select>

					<h5>Reason for visit</h5>
					<input id="ReasonForVisit" type="text" placeholder="Reason for visit"  class="input-block-level"/>

					<h5>Consent to use picture for:</h5>
					<label class="checkbox"><input id="cbStorage" type="checkbox" name="concent" value="store" /> Storage </label>
					<label class="checkbox"><input id="cbResearch" type="checkbox" name="concent" value="educate" /> Research </label>
					<label class="checkbox"><input id="cbEducation" type="checkbox" name="concent" value="education" /> Education </label>
                    <br />
                    <input type="button" id="btnUpdateImage" onclick="app.update();" value="Update Image" style="width: 100%;" data-theme="a" class="btn btn-large btn-primary" />
                </div>
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